A health care ‘watershed’

2013 October 31

by Rick Holmes

The biggest of the many big lies about Obamacare is that it’s a “government takeover of health care.” In reality, it leaves the toughest work in health care – restraining costs without compromising quality – solidly in the hands of private health care providers and private health care insurers. Its big idea is that by realigning the incentives, it can make the free health care marketplace work better.

In a meeting at our offices in Framingham yesterday, Robert G. Romasco, the president of AARP, described Obamacare as a “watershed moment” for health care.

Up to now, he explained, insurance companies have made their money by collecting as much as they can in premiums, and paying out as little as possible to providers. They tried to insure the healthy, less expensive, people, while avoiding having to insure the unhealthy people. They shifted costs, discounting premiums for large employers and negotiating lower prices from providers, then making up for it by overcharging in the individual and small-business markets. Hospitals and physicians made their money by performing more services on patients. Nobody made money for keeping people healthy.

Obamacare changes that, Romasco explained, by “making the insurance companies the good guys.” Now they have to cover everybody, and they can’t drop clients who get too sick or cost too much to treat. So they make money by working with providers to reduce the need for expensive services – by keeping people healthier.

Figuring out how to do that is the job of insurance companies, hospitals, physicians and the rest of the medical establishment, not “big government.” Republicans supported the ACA model for decades because it’s a market-based system that doesn’t replace the insurance industry with government bureaucrats. The health care sector of the economy is healthy and competitive, with lots of innovation going on. Obamacare keeps it that way.

Section 3403 of the Patient Protection and Affordable Care Act (PPACA) established the Independent Payment Advisory Board (IPAB), responsible to reduce the per capita rate of growth in Medicare spending.

Rick obviously thinks this board is going to leave up to the health care providers to reduce costs. In fact if Rick’s contention were true – restraining costs without compromising quality is solidly in the hands of private health care providers and private health care insurers – there would be no need for this board. Rick’s contention is what I call a Chris Matthews piece of logic. Penalizing people for not particpating in specific, minimal health care coverage as designed by a piece of legislation is not a government takeover. Say that 100 times and you can convince yourself it is true. Rick and the AARP apparently would have us believe having a governmental panel, not the insurer or the insured, decide what types of medical care are to be covered by insurance for a certain segment of society is not a government takeover of the market or the individual’s participation in that market. In fact it is wage and price controls under government legislation.

Need I point out that the government controlling and determining health care coverage in very specific ways and how it is to be financed – Medicare, Medicaid, the PPACA – is a blatant takeover of the health care industry. It the institutionalization and creation of a Nancy concern, the medical health care complex. But as Rick would say – so what’s the problem with that? Like Chris Matthews it is the way he sees things and the way it should be applied. What’s the problem with that?

I believe you are mixing apples and oranges here. Medicare is the equivalent of a private insurance company covering people over 65, and has been since 1965. IPAB gives Medicare the authority to decide not to reimburse providers for treatments that don’t work. That provision isn’t as strong as I’d like – it doesn’t allow IPAB to consider whether a treatment is cost-effective, just whether it’s effective.

Your implication is that when the government buys a service, it shouldn’t care how much it pays for it. How can so-called conservatives take that position?

I want insurance companies to be able to evaluate these things, whether the insurer is private or public. The alternative is to give a blank check to anyone with a Dr. before his name. I want Medicare to have the power to rein in costs. It’s our money. I don’t want to see it wasted. Do you?

I’m mixing apples and oranges? The government forces everyone to sign up for Medicare when s/he turns 65. The individual has no say in the matter. The government decides what it wants to reimburse providers. It obviously cares what it is paying providers. When you say youwant Medicare to have the power to rein in costs, you are saying you want the government to have the power to control the market. Explain to me how that isn’t the government taking over a market.

That’s just silly. Go to the website and look at the names of the folks you’ll send your checks to: Private companies. The website is like the Pike service plaza parking lot where the farmers sell their crops. You’re still buying from a private farmer.

That’s just disingenuous, or more Chris Matthews, on your part. Of course I send my checks to private parties. But the government is telling them and me what I have to have for minimum coverage, in the case of insurance companies, and the IPAB will eventually decide what services are going to be covered by insurance in order to control costs. And as an individual if I don’t do what the government says I have a penalty or tax.

Rick, premiums have to go up if people with pre-conditions must be covered . That situation raise the actuarial risk pool upon which the premiums are set.Can’t you see that?or are you purposefully ignoring that?If the minimum coverage standards are raised it means more procedures and conditions go into the risk coverage pool and premiums go up. Can’t you see that?

If the Pike is setting prices for McDonald’s at the rest stops, that’s news to me. The only restriction I’ve ever heard of – and I don’t know if it’s still in place – was a rule thke Pike handed down years ago to keep Pike gas stations from charging rates higher than anywhere else in the state.

I don’t know what you envision, Don. You don’t want Medicare to have any say in how taxpayers’ money is spent on health care. And I assume you don’t want private insurers to exercise any control over what they pay out to doctors and hospitals. No wonder we pay more for health care than anyone else in the world. The health care industry just sticks a siphon into the pockets of consumers – the public pocket on one side, the insurance companies’ pocket on the other – and we have no choice but to raise taxes and premiums to pay for it. Quite a system.

You never make an attempt to understand what I am trying to say. Like the world would end. Medicare is a legislative act of the US government that controls healthcare in the over 65 segment of the health care market. It sets prices and premiums. You and I have absolutely no say in the matter. That is the definition of control. Now the PPACA is determining who must have insurance and what standards that insurance must meet or what penalties or taxes must be paid if non-participation occurs. How can I make you understand or see that kind of control is takeover? How can I make you see a basic fact? It doesn’t mean I endorse tactics of insurance companies; it doesn’t mean I wouldn’t like to see costs corralled although you try to muddy the waters by ascribing beliefs to me that don’t exist, like some bad Roseanne Roseanneadana skit. I am just saying the government is taking over the healthcare industry. There are a number of rationales that individuals like you believe are correct to support that takeover. You are front and center with single payer, the ultimate in government ownership and control. I don’t like that, just like I don’t like many other proposed government control situations. As I said elsewhere, I believe you gravitate to government in all control situations as a way of guaranteeing the common welfare. I don’t think that is why the country was formed and constructed, not do I think it the correct future path. I think you do.

One difference between Medicare and private insurers: Blue Cross/Blue Shield can negotiate volume discounts with drug companies, just like Papa Gino’s can negotiate volume discounts on tomato sauce. So can the Veterans Administration. But Medicare, the biggest purchaser of many drugs is prohibited by law from negotiating discounts. It’s a tribute to Big Pharma’s lobbying budget.

Insurance companies dicate reimbursement levels. You can call an insurance company to verify benefits and they’ll tell you the rules. Well until you submit a claim, then they refuse to pay, you call them and they say, ooops, we misquoted benefits, refuse to pay and put the responsibility for payment on the patient. Not fair but it’s been going on for decades. It’s misleading and usurious business practices. Who’s gonna change that? No one, the insurance companies are in control.

Not everyone has to have Medicare. At 65 or when someone starts receiveing Social Security they are automatically enrolled in Medicare Part A which covers hospitalization. Medicare Part B covers doctor’s visits and not everyone has to enroll in it. Has anyone ever heard of Medicare advantage plans? Instead of having Medicare, seniors can sign up with private insurers and have private health insurance plans which replace Medicare. Well until they go onto hospice care, then coverage reverts back to Medicare, meanwhile the Medicare advantage plans collect the premiums and the tax payer picks up the costs of the hospice care. Not fair to the tax payer but lucrative for private insurance companies.

In the future there won’t be enough doctors to see people, they’ve been driven out by private insurance companies. Government control can’t or won’t prevent this from happening. In the end we all loose.

Not that anyone cares — unless you are on Medicare or are helping a parent who is on Medicare — but the description of Original Medicare Parts A and B and public Part C Medicare Advantage health plans above (in particular Part C’s relationship with hospice care) by Nancy Lindsay is totally incorrect. Again it does not matter unless you are on Medicare or are helping a parent who is on Medicare but if that is the case this political propaganda could mislead you and cause you to make a bad decision for your finances and your health. If you have a question, go see the SHINE person at the senior center because this information is totally incorrect.

Oh no Dennis, I’m not passing out insurance advice nor peddling propaganda. I’m stating how insurance companies collect premiums and keep them while denying claims, especially the Medicare Advantage Plans administered by health insurance companies. And I too would urge all seniors to consult with a SHINE counselor, otherwise they’ll get rooked and think they have insurance, but file a claim and aww, that’s not covered, bill the patient. Those are facts.

Thanks for pointing that out to me Tom; example of furthering conversation or elevating debate?

Here is a list of the 11 major errors concerning Medicare that this Democratic Party propagandist has managed to make in just three or four sentences. Again, I urge anyone needing Medicare advice or helping a parent with Medicare issues to go to the senior center. Do not believe the propaganda like this purposely misleading comment above:

1. “Not everyone has to have Medicare.” I am not even sure what this means but — as I said above in response to Don Brophy — everyone has to pay for it from the minute they start working. So they may as well take it?

2. “At 65 or when someone starts receiveing (sic) Social Security they are automatically enrolled in Medicare..”

— You do NOT get Medicare when you start receiving Social Security.
— You do NOT get Medicare automatically when you are 65.

3. “Part A which covers hospitalization.” Part A covers hospitalization ONLY if you are admitted. Many people are hospitalized but only observed. In the latter case, Part B covers you. This is to your benefit in most cases but not always. Make sure you understand the differences and make sure a son or daughter understands the difference (since if you are hospitalized under emergency conditions, you likely won’t be in any condition to figure it out then).

Part A ALSO covers blood, some home health services, skilled nursing facility care (that does not mean a nursing home), and hospice care (see the inaccurate statements about hospice care by this propagandist that I try to clarify in points 8-11 below).

4. “Medicare Part B covers doctor’s visits..” Again, more Medicare misinformation by this Democratic propagandist (but in this case I can not even fathom what the political motivation is). As mentioned above part B covers inpatient hospitalizations where you are only observed as well as basically everything else that is not mentioned in point 3 above, particularly outpatient hospital and surgical center activity (except that no part of Original Democratic Party Medicare — Parts A and B — covers annual physicals, dental work, vision care, hearing aids, drugs bought outside a hospital, acupuncture. cosmetic surgery, nursing home care -also called long-term care or custodial care — or healthcare outside the United States even if needed on an emergency basis).

5. “and not everyone has to enroll in (Part B).” That’s literally true but you do have to enroll in it if you want Part C, or private Medigap insurance and most employer sponsored retiree insurance. So basically everyone (98% of us) have to enroll in Part B if they are retired.

6. “Has anyone ever heard of (public Part C) Medicare advantage plans? Instead of having Medicare…” This is a complete lie and standard Democratic Party propaganda (the Democratic Part has been trying to defund and repeal the public Part C Medicare health plan program ever since it was signed by President Clinton in 1997). Part C is additive to and a Part of Medicare. That is what the word Part means. Part C is not “instead of” Medicare. You cannot get Part C unless you have Parts A and B

7. “seniors can sign up with private insurers and have private health insurance plans which replace Medicare. ” Same lie as point 6. This is from the Democratic Party propaganda playbook of telling a lie over and over again. But I have never actually seen the same lie told twice in the same sentence.

8. “Well until they go onto hospice care, then coverage reverts back to Medicare..” Hospice coverage doesn’t “revert back to Medicare..” A public Part C Medicare Advantage beneficiary is ON Medicare Parts A and B as well as C (has to be to get C).

9. “meanwhile the (public Part C) Medicare advantage plans collect the premiums..” Again, it is unclear what the propagandist even means by this phrase. Of course the plan continues to collect the premiums IF the beneficiary or his or her healthcare proxy wishes to continue the Part C coverage for drugs and medical issues having nothing to do with the hospice care (but the person in hospice could also drop Part C if desired and then the plan would not “collect the premiums.”) What is the point?

10. “and the tax payer picks up the costs of the hospice care.” That is not correct. The taxpayer is not picking up the hospice cost; the Part A trust fund pays for hospice care as I mentioned in point 4. The beneficiary has paid for his or her hospice care by contributing to the Part A trust fund for 40-55 years. The taxpayer has nothing to do with it (other than of course the beneficiary is also a taxpayer).

11. “Not fair to the tax payer but lucrative for private insurance companies.” Again there is no taxpayer involved in hospice care. But there is a private insurance company involved in every Medicare dollar — not just hospice care Medicare dollars — whether we are talking about Parts A, B, C or D. In Massachusetts, a person receiving hospice care would have the bill paid for by Wellpoint Insurance Company of Indiana, possibly — I’m not positive — the largest private healthcare insurance company in country.

Again, what’s the point? Would you rather the non-profit Tufts Health plan — the largest provider of public Part C Medicare Advantage health plans in Massachusetts and run by President Obama’s buddy James Roosevelt — pay the hospice provider? Why? The money all comes out of the trust funds no matter who writes the check.

I think that what has totally been lost in the whole debate is that the founding fathers had a profound insight that is totally ignored–federal government just can’t do certain things and shouldn’t do certain things. So instead of merging the states into a unified country, the created a system that devolved social policy to the states and big interstate stuff, war and diplomacy to a central government. nothing proves the point more than health care, medicare or social security, education policy, the EPA and so forth. they are all nightmares and they all need to go. now. even Hamilton foresaw that a federal government that tried to run the life of every citizen would eventually bankrupt itself, and that’s where we are heading, and instead of rollback, we are getting expansion. the rasmussen poll from Friday shows a plurality of 78% that want either repeal or major bipartisan reworking of Obamacare, but Barry decides the answer is to re arrange the deck chairs and change the subject. there is a total disregard for the people, the constitution or the truth coming from this Regime.

Again, I speak for myself Dennis, my name is Nancy not propagandist. If you have Blue Care 65 or Tufts Medicare Preferred, Medicare replacement products, and you go on hospice care, the hospice care is paid for by Medicare not Blue Care 65 or Tufts, who will still collect the premiums and keep them. Wellpoint insurance would not pay for hospice care, Medicare would pay for it. Wellpoint would deny the claim stating hospice is the patient’s primary insurance, bill them.

What is the difference between 1985 and today, besides 28 years? Insurance companies have taken over medical care in this country while monopolizing and eliminating competition. Say this out loud and it’s propaganda.

But thanks for the flattery or the denigration, Dennis. If I really was a Democratic Party Propagandist, would they reimburse me? Then I’d have more money to give to the insurance companies to keep, so they can deny claims and rip off Medicare, a tax payer funded program which the Republicans want to see dismantled.

Nancy, you are a danger to senior citizens spewing your inaccurate Democratic Party propaganda.

1. What you don’t seem to understand is that Wellpoint Insurance — not the government — pays all Original Medicare bills in Massachusetts, including h0spice charges.
2. And no on hospice has to keep his or her public Part C plan (and therefore keep paying premiums) but they typically do in case they have other medical and drug needs — other than the one that requires hospice. Similarly, people on private Medigap plan typically keep that when in hospice.
3. Public Part C Medicare Advantage plans like the two you mention are not “Medicare replacement” products. They are Medicare supplements.

I know you believe that President Obama has always spoken the truth about this subject but now that we know what a problem he has telling the truth about anything to do with medical insurance, I would think you would begin to have doubts.

This is among the oddest of all of the extremely odd posts by this author.

An insurance company executive came in to the newspaper to bash what insurance companies “used to do?” Just for the record Romasco was an insurance company executive – a chief marketing officer at CIGNA – when all these bad things happened. Is this Mr. Holmes version of Howie Carr writing The Rifleman’s bio. Romasco has also apparently been involved in creating infomercials, worked at JC Penney (hopefully not during the ill-fated makeover), and – closest to home – was one of the NSA-like guys at Epsilon, who eat up all that info you give retailers when you swipe your discount card and use the data to try to predict what you are going to buy next.

For some reason Mr. Holmes doesn’t make it clear that the President of AARP is not an executive of the AARP insurance company but a “volunteer” front-man spokesperson. He has nothing to do with the operation of AARP, an fact that might not come across if you look up the word President in a dictionary. (Also just for the record, AARP is not really an insurance company but just the front-man for an insurance company called United Healthcare the way Romasco is a front man for AARP. United Healthcare — possibly the biggest insurance company in the country that actually sells insurance but I am not sure — gives AARP a couple or three billion dollars a year to call its insurance AARP insurance instead of United Healthcare insurance. The idea — something you would expect from someone that made infomercials — is to trick senior citizens. But that’s why the AARP magazine – which my wife says is pretty good – is so cheap.)

Now according to Mr. Holmes, the AARP front-man said

“Up to now, insurance companies have made their money by collecting as much as they can in premiums, and paying out as little as possible to providers.”

But with the possible exception of the AARP insurance company, most insurance companies do not sell healthcare insurance (and therefore they do not do all the bad things Mr. Holmes claims they do or did). I can’t call what Mr. Holmes says Mr. Romasco said a lie because I don’t know the context. And I am fairly convinced after reading his material the last few years that Mr. Holmes just does not know enough about the subject of health care insurance to understand whether he was being lied to or not.

I AM making an assumption that we are talking about health insurance.

If so, “up to now” most people – by a wide margin — are in one of three categories when it comes to their health insurance, none of which involve insurance companies making money by collecting premiums and not paying claims.
— Most of us are in self-insured health plans funded by our employers. If the insurance company administering your insurance under contract to your employer denies your claim, your employer gets the money, not the so-called insurance company.
— Or we are on Medicaid. If the insurance company administering your Medicaid claim denies your claim, the state of Massachusetts keeps the money, not the so-called insurance company.
— Or we are using the Medicare benefits we paid for over the last 40-50 years. If the insurance company administering your Medicare claim denies your claim (all Medicare claims go to an insurance company, not the government like the government wants you to think), the U.S. Treasury keeps the money, not the so-called insurance company.

In Massachusetts those three categories account for 90% of us residents. (Because other parts of the country are not as old as we Massachusetts residents in general or do not live in a state this is as generous with welfare benefits as Massachusetts, I would guess that the national average is more like 85%.)

FYI: I do have a new policy (same provider), with a higher deductible, that kicked in a couple of years ago. Insurance policies change, and premiums go up. In the case of the employer-provided policy that covers my family, the changes had nothing to do with Obamacare or Romneycare (far as I know) and everything to do with rising health care costs.

I assume you misposted this reply because I don’t see any relation to my comment?

(Correction: I said that around 90% of Massachusetts residents use insurance where the insurance company is simply an administrator rather than an insurer. It is probably “only” around 80%. Over 60% of employer plans — not all plans — are self insured so that reduces the total from myfirst estimate.)

Health insurance is not just health insurance but rather prepaid medical with an insurance component.

Consider the analogy of food to health care.

If we were paying a monthly amount for our food to someone other than the food supplier who then paid for the food, this factoring agent would need to make a profit for the service. In addition, the factoring agent would insure that we get our food no matter what happens (famine, catastrophe etc.) and they would make a profit off of this insurance. Sounds completely ridiculous…

So now go to health insurance. We prepay for our routine care (monthly food) and pay extra just in case something really bad happens, and provide huge profits to the factoring agent.

A better system:

People pay for routine healthcare out of their own pockets directly to the providers

People buy insurance (by definition: protection against a large unforseen loss) for the unknown catastrophe.

Ted Kennedy had it right for the less well off, government run community health centers.

Our government has sided with the factoring agents (insurance companies) to extract massive amounts of money from all of us in the name of profit….not common sense.

The watershed moment was when we were forced to buy into this utterly nonsensical financial extraction scheme by insurance companies by none other than Willard M Romney….

“If Obama were the CEO of a private company, writes George Mason University economist Don Boudreaux, “he would be sued, publicly lambasted by all the major media, perhaps hauled before an admittedly grandstanding Congressional committee, and possibly prosecuted, convicted, fined, or even imprisoned for fraudulent misrepresentation.”

Jeff Jacoby in the Boston Globe, November 3, 2013

That’s a pretty big “IF.” Maybe if Americans could become convinced that we are still a self-governing country and that presidents, senators, representatives, heads of cabinets, secretaries of departments ( like Kathleen Sebelius) and supreme court justices are public servants whose salaries we pay with our hard-earned taxes (those of us who still have jobs) we would make them accountable, not just in word, but in deed.

President Obama knew at the time he was telling Americans that they would be able to keep their own health plans and doctors that it was untrue. In effect, he blatantly lied to all of us. Over and over again.

“Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, “40 to 67 percent” of customers will not be able to keep their policy. And because many policies will have been changed since the key date, “the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range.”

“That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.

“Yet President Obama, who had promised in 2009, “if you like your health plan, you will be able to keep your health plan,” was still saying in 2012, “If [you] already have health insurance, you will keep your health insurance.”

How many times does a person have to lie before you can call him a liar?

Of course, Barry would never be a private CEO; he’s never worked a day in his life. But jennie, the real scandal is that people like me have been saying this for over two years, and Barry and hus kool aid drinking minions have not only been in denial, but they’ve been defaming and insulting everyone who pointed out that the emperor had no clothes.

I appreciate Dennis and Bob making some attempt to focus on the substance of what the AARP guy was saying, though I’m not convinced that insurance companies have no incentive to deny coverage or to avoid covering sick people. Remember, we’re talking about the individual market – that’s what the ACA was intended to fix. Obama’s oft-cited, inaccurate campaign promise was intended, in part, to reassure 85 percent of the people who are not on the individual market that current employer-based and government health insurance programs were largely unaffected.

For Rob and Jennie, on the other hand, the only important thing to understand about health insurance is how much they hate Obama. The more they talk about his campaign pitch, the more it seems like they are missing the point. We’ve got a real program being implemented, and it’s more important (not to mention more interesting) to talk about how it really works. The part about setting minimum standards for creditable coverage was in the bill, and was in Romneycare. Now we’re seeing what it means for people who were previously paying for “insurance in name only.”

Yes, some people are losing their old policies and getting new ones. Change happens. What Obama said five years ago is less important than what is happening to real people now. Will the new insurance they get be better or worse? Will they be able to afford it? Will it mean fewer medical bankruptcies down the road?

The point, Rick, is that this is not about health care or insurance. It is about the relationship between the citizen and an oppressive government. The rule has always been that if you don’t want to deal with the government, you can pretty much keep away from it. There has been a fundamental and I believe constitutional shift in power here, and it will require repeal of Obamacare to restore the balance, which is what the Tea Party will keep fighting for. I’d rather pa the penalty and donate to Tea Party candidates that buy into this rotten scheme.

That is not all it is. The act itself is about access, cost control, and required minimal coverages/participation as determined by the act. For you it is only about trying to help millions. For others it is the manner in which that help is determined and applied and how it affects, as a minimum, the others not in your “help” category.

Obamacare is the most existential threat to our freedom since Lincoln launched his war of aggression in 1861. Nothing is more important than upholding the freedom of the individual to contract. without that, we have no country.

It’s good that you introduce the Lincoln analogy. I will credit you with candor when it comes to ideological extremism. Holding out Lincoln as the oppressor and pining as you do for the good old pre-13th and 14th amendment America, it becomes obvious your notion of freedom extends to a select few. Those held in slavery were just history’s short straw holders, not to be seen as fellow human beings, let alone citizens. Property. Similarly those today on the lower rungs of our society without any innate human value in your eyes are simply not worth the price of some industry regulation and a modest tax surcharge leveraging participation in the marketplace. For you the word “free” connotes what you shouldn’t be asked to pay for.

There’s a huge gap in perceptions here. Rob calls Obamacare an “existential threat.” Jennie’s hero Ben Carson compares it to slavery. They are operating at a philosophical, theoretical level that, I guess, backs up the emotionally-driven opposition to anything associated with Obama.

I can only see it on a practical level. It’s a limited government policy intended to remedy a few problems with the health care delivery system. It’s more a tweak than a revolution, as evidenced by the fact that 85 percent of Americans will be largely unaffected – and that the most basic rights of all Americans – to vote, to speak, to move, to work, to worship – are untouched by this act. The loss of the freedom of the free-rider to go without insurance is, at best, a third-tier right.

Now we’re in the implementation phase, when the theoretical debate should give way to the reality. That reality is that, for a few million Americans, their health insurance policies will change. Not even in the wildest imaginings of Rob can an increase for some people in their health insurance premiums be confused with an existential threat to the nation. But the people driven by philosophical or emotional opposition are pouncing on website shortcomings as some kind of vindication.

The government can force certain of its citizenry to participate in an economic activity or penalize it if it doesn’t. One party of the political ruling class can now decide what is best for its citizenry under an artifical “reconciliation” construction and that action is blessed by the Supreme Court. Nancy’s perfect storm. Whether one crosses the Rubicon at its most benign point or at its most violent, one still has crossed the Rubicon.

It’s practical to stop and frisk. It’s a limited government policy designed to remedy a few problems with the high degree of law breaking activites by a demographic group. It’s more than a tweak than martial law, as evidenced by the fact that probably 99.99% of Americans will be largely unaffected. The loss of momentary freedom in quest for the safety of the population is at best a third tier right. Logic was left behind long ago.

It’s practical to require a voting ID. It’s a limited government policy designed to remedy a few problems with illegal voting. It’s more a tweak than unConstitutional, as evidenced by the fact that that probably 99.99% of Americans will be largely unaffected, having the appropriate ID as a basic function of living in this society. The loss of voting privilege for a very few in quest of making sure the vote is not tainted by those ineligible to vote is a best a third tier right. Logic was left behind long ago.

hell, its more practical to murder a criminal suspect with a drone than bring him to trial. And where the hell is the problem in forcing an abortionist to have privileges at a hospital, when doing so is a policy decision that will only affect about .001 percent of the population. Clearly, the freedom of that small group of women to object is just philosophical.

All these counter-examples can be put to a cost-benefit analysis and be the focus of rational debate. Those prone to exaggeration can compare stop-and-frisk or voter ID laws to slavery and, if Rob’s in the debate, I’m sure Hitler will be involved. I’m more interested in whether these approaches address a real problem (which fraudulent voting isn’t) and whether they unfairly impose harm on a segment of the population (stop and frisk) without an off-setting good.

I’d argue that lack of access to health insurance is a real problem, that the ACA doesn’t unfairly or unreasonably punish a segment of the population (OK, maybe medical device manufacturers and unions with cadillac health policies). But the costs and benefits can be raised without all the hyperbole about universal health coverage being a threat to the very essence of life as we know it.

Stop and frisk laws and voter ID laws aren’t argued against by opponents under a cost benefit analysis, if my understanding of the opposition to those actvities is correct. I’ve never seen that argument here. Your rationale on behalf of the PPACA is practicality and cost benefit analysis. Mine is in the other corner, that practicality and cost benefit can justify anything from the government’s perspective (or anyone with the upper hand as it were) and in this situation it is really convenient to use it as an argument because, well, it fits the ends. Opponents don’t use it for S&F or voter ID because, well, it doesn’t fit their ends. It’s like the all purpose rationale.

I see costs and benefits argued all the time, often with a mix of constitutional philosophy thrown in. Homeland security vs. privacy rights. Tax cuts vs. public investment. Bloomberg argues the benefits of stop & frisk in reducing crime outweigh the costs in hassling innocent people. The benefit of making it easier to vote vs. the cost of longer poll hours and (perhaps) more voter fraud.

Right now I’m weighing the costs and benefits associated with letting a casino open in Milford. It’s not the only way to argue a public question, but it’s certainly legitimate.

I wonder about this from time to time. Do you realize the Democrats have won in matters of health care, that their agenda will be imposed and there is nothing anyone opposed to that process can do about it? And that a form and style of government not of, by, and for the people has been institutionalized and you are in full agreement with that evolution? Oh sure there will be some bitching and moaning, much of it valid, but it is all pretty much irrelevant to that institutionalization. I often wonder why you feel compelled to rationalize the foregone conclusion.

Not sure what you mean. Democrats have won some and lost some on health care. I was just looking at a slideshow history of efforts to create a national health insurance policy. Teddy Roosevelt proposed it, as did FDR, Truman and JFK. All failed. LBJ got Medicare and Medicaid. Nixon proposed an employer mandate and failed. Carter created a Medicare prescription drug benefit, but it was repealed after a year (guess it wasn’t a foregone conclusion). Reagan gave us COBRA. Hillary tried for universal coverage and failed. W got the prescription drug benefit. Obama got the ACA, but whether it lasts is still in doubt.

So it sounds like Democrats and Republicans have both tried to improve health care for Americans, failing at least as often as they succeeded. And all of them were elected “of, by, and for the people.”

You wonder why I keep defending health care reform? Why? Because nobody is discussing it except me? I wish. I’d love to move on. I thought the fight was over when the legislation passed. But it wasn’t.

Something I was thinking about this morning while trying to herd guest high school students out the door–some unwillingly or at least grumblingly– in time for school. Folks who haven’t reached a certain level of maturity can’t quite see why they should have to give up every little personal preference–like sleeping late, or avoiding breakfast–to accomodate other’s needs or better practices. It’s probably why more and more marriages fail ;because each partner in a long marriage WIL be faced with having to give up even more substantial wishes and preferences for the good of the whole. We’re seeing that here: I bet those guys who are whining loudest must have mates that bend in supplication to those whiners’ every whim. Or wish they did.

Mistake in communication above there: I mean the immature can’t see why they can’t retain every little personal preference. I guess we all ought to be able to retain one or two preferences.J ust not irresponsibility in participating in health care that benefits us all.

Rick, our entire experiment in democracy arose from enlightenment, which is a philosophical movement. This is what sets up apart from the “kill the landlords” approach of Cambodia or Russia. Our Founding Fathers read books. When you make lofty arguments that people who oppose Barrycare are doing in on some artsy fartsy bookish philosophical level, I am more than happy to be placed in the category of the Founding Fathers. You bet I object to barrycare on a philosophical level as opposed to some knee jerk political level.

Everyone should eat their broccoli and regularly exercise while this gets sorted out. Red wine in moderate portions where appropriate would be helpful as well. And yes, try to have intelligent and caring health care proxies, ’cause it’s complicated– as it has been for decades. The big problem is; these are new and unfamiliar complications to some extent, and in an area that makes many people nervous.

The Randians, of course would love the government to get out of all of this so the poor and unfit die out rapidly. What they forget is that eventually many of those same Randians would slide under the curve of cost-effective medicine and thus become themselves unfit to survive. What a nice world that would make!

The Johnsonian Democrats among us would like to see some reasonable regulatory controls over insurance companies so they don’t abandon the less-abled or sick for venal reasons, and for the government to encourage effective, efficient and just controls of cost and economies of scale that aren’t warped to benefit only corporations by lobbyists. What we don’t want to see and shouldn’t be accused of wanting are “Soviet-era government takeovers.” Given the even worse (?) corruption in the former USSR precincts, no person wants that straw man.

About this blog:

Holmes & Co. is a Blog for Independent Minds, a place for a free-flowing discussion of politics, policy, news and opinion.

This blog is the online cousin of the Opinion section of the MetroWest Daily News. As such, our focus starts in the MetroWest/495 area and spreads from there to include Massachusetts, the nation and the world. You'll also find here lots of cross-referencing to columns and editorials in the MetroWest Daily News.

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